Our focus and priority is on providing the South African healthcare market with leading Gap Cover solutions, which serves as a vital “must have” insurance solution to your medical scheme cover.

Gap Cover is not a replacement for a medical scheme, but merely complementary in design and application to registered medical schemes in South Africa.

Recognising the plight of the continuously financially over-burdened South African consumer, we at Sirago offer short-term accredited Gap Cover solutions for the more than 9.5 million beneficiaries participating in the private medical scheme industry of South Africa to assist with their potential financial burdens in the event of a health event / crisis. Our priority is to provide our policyholders with the peace of mind to focus on recovery and recuperation, which is why we do our underwriting at application, rather than claims stage.

Sirago focuses on offering unique Gap Cover solutions tailor made for the uniqueness of the South African healthcare market. Our options and solutions are developed, to be applied generically to any medical scheme option in the market.  As part of the design framework, Sirago has catered for all life stages and events to ensure that once your policy is active within Sirago, you never have to leave. 

The product development cycle at Sirago, is ostensibly focussed on the retail medical scheme market where effective analysis and due diligence is undertaken to ensure that we provide benefits for all the major hospital events that consumers could face.

The real focus of gap solutions is on the in-hospital activities and provides a strong financial safety net for consumers when the provider charges more than the medical scheme is contracted to pay.  Currently, when looking for gap solutions, the key focus should be on the tariff differences, the co-payments and penalty fee impacts, where the scheme imposes sub-limits in certain benefit categories, how the scheme manages cancer cover and then emergency room cover.  Sirago focuses its product development medical scheme benefit design.  Because of these medical scheme limitations, Sirago needs to assess and understand what the impact on the gap policy will be in terms of premium rating, loss ratios and pricing for risk to ensure long term sustainability. 

Sirago is underwritten by GENRIC Insurance Company Limited, an authorised Financial Services Provider and registered Short-term, non-life  Insurer. Our core business revolves around the provision of critical benefits to policyholders who are faced with unforeseen medical expense shortfalls, which are not fully covered by their medical schemes.

It is no secret that the availability of basic healthcare services in South Africa, is less than adequate. Specialised health services are even more inaccessible to the average citizen. In South Africa the lack of structured mechanisms to ensure that funds are spent effectively, often results in inadequate quality control, and insufficient proper standard risk management and social healthcare programs, which results in the State continually having to manage the healthcare demand with ineffective use use government healthcare funding.

The traditional risk-transferring between funders and members of the medical scheme remains a challenge for both member and gap providers.  One of the key issues for consumers to appreciate and understand, is that a gap cover policy is not a “fail safe” for all the claims not settled / paid for by their medical scheme.

In addition to the above, medical service providers have also become aware of Gap products and in some instances are altering their billing practices to charge more than the rates agreed between themselves and the contracted medical schemes.  This results in significant financial pressure on the gap providers to maintain competitive premiums management. 

Insurance solutions in South Africa are primarily measured on the effectiveness of administration at claims stage.  This is not foreign to us at Sirago and we endeavour to ensure fast and effective turn-around times in all administration functions.  As part of this success, Sirago has daily claims payment runs, which is not always typical in this industry segment. 

Healthcare financing can be a complex environment.  At Sirago, we realise this fact and this is why we have partnered exclusively with independent and corporate financial advisors, who in turn provide effective and objective advise to prospective members.